TALLEY’S
Appliance Sales & Repair Service
Online Service/Purchase Request
Name:
Phone Number including area code:
E-mail Address:
Type of Service Needed:
(Please check all that apply)
Washer Repair
Dryer Repair
Refrigerator Repair
Range/Oven Repair
Other Appliance Repair
(Please list appliance type)
I am interested in purchasing:
Washer
Dryer
Refrigerator
Range/Oven
Other Appliance